Do Specialised Geriatric Wards Improve Patient Outcomes

• Published in: Age and ageing Vol. 53; no. Supplement_4
• Main Authors: Lynch, Amy, Cormican, Niamh, Cashen, Aoife, Chan, Kei Yen, Devaney, Kathy, Robinson, Stephanie, Small, Cliona
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 29.09.2024; Oxford Publishing Limited (England)
• Subjects: Clinical outcomes; Delirium; Dementia; Dementia disorders; Documentation; Functional impairment; Geriatric wards; Geriatrics; Health care; Hospitalization; Length of stay; National guidelines; Nursing; Older people; Organization development; Organizational change; Patients
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afae178.136

Abstract Background Older adults demonstrate a unique set of needs in an acute healthcare setting. Admissions increase risk of hospital acquired disability including delirium, infections and functional decline with heightened risk of institutionalisation. As per national guidelines, acute hospital care of older patients should be carried out on a specialised geriatric ward (SGW). This aligns with Slainte cares “right care, right time, right place”. An organisational change project was implemented to set up an SGW in a tertiary centre. Assessment and documentation of delirium along with length of stay (LOS) were assessed as a surrogate marker for improvement in patient outcomes. Methods A retrospective assessment of patient demographics, LOS and delirium documentation for a 3-month period in 2023 was reviewed and compared to the same 3-month period in 2024 post inception of the SGW as part of a service development project. Results Mean age was 83 in both groups. 11% (18/157) pre SGW and 30% (40/134) post had dementia. 91% (122/134) had a collateral history and CGA during their stay on the SGW compared to 78% (123/157). 89% (119/134) had a 4AT documented at any point in the admission post SGW compared with 16% (26/157) previously. 80% (107/157) had a 4AT documented by nursing compared with 0% prior. It was estimated that there were 1,514 bed-days saved. Conclusion The implementation of a novel SGW is a complex service development project that utilised organisational development and had a focus on the people underpinning the project at all levels in planning for success. A significant improvement was seen in delirium recognition and documentation using the 4AT at all levels. The most significant improvement was seen in nursing documentation of the 4AT. A significant improvement in “bed days” and patient LOS was observed. This project serves as the business case for further development and sustainability of our SGW.